Endoscopic third ventriculostomy for idiopathic normal pressure hydrocephalus

• Serial Assessment of Gait Changes After Interventions Using Smart Insole in a Patient With iNPH: A Proof-of-Concept Case Report
• Ventriculoperitoneal Shunting Versus Endoscopic Third Ventriculostomy for the Surgical Management of Idiopathic Normal Pressure Hydrocephalus: A Retrospective Cohort Analysis
• The effectiveness of various CSF diversion surgeries in idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis
• Regulation of brain fluid volumes and pressures: basic principles, intracranial hypertension, ventriculomegaly and hydrocephalus
• A Single-Centre Experience of the Management and Surgical Outcomes of Late-Onset Idiopathic Aqueductal Stenosis
• Is endoscopic third ventriculostomy a viable treatment option for normal pressure hydrocephalus? A systematic review
• Comparison Between Ventricular and Spinal Infusion Tests in Suspected Normal Pressure Hydrocephalus
• Ventricular CSF proteomic profiles and predictors of surgical treatment outcome in chronic hydrocephalus

Initially reported for normal pressure hydrocephalus in 1999 ¹⁾.

Mechanistically, it is difficult to explain why ETV would work for NPH, but it has been advocated by some ²⁾ in highly selected patients, using nonvalidated outcome measures, quoting post-op improvement in 69% of patients. At this time, ETV should not be considered a first-line treatment for most cases of NPH.

ETV and VPS did not differ significantly regarding their failure rate for iNPH, while ETV showed a significantly lower complication rate than VPS. However, the data available is scarce with only one RCT investigating this important matter. Further well-designed trials are necessary to investigate the clinical outcome of ETV in iNPH ³⁾

The only randomized trial of endoscopic third ventriculostomy (ETV) for idiopathic normal pressure hydrocephalus (iNPH) compares it to an intervention which is not a standard practice (VP shunting using a non-programmable valve). The evidence from this study is inconclusive and of very low quality. Clinicians should be aware of the limitations of the evidence. There is a need for more robust research on this topic to be able to determine the effectiveness of ETV in patients with iNPH ⁴⁾.